MEDICARE: MIKEAL ROBERT OSTRANDER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3296-35	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3296-35	OTHER	WI	WISCONSIN OPTOMETRY EXAMINING BOARD

General Provider Information

NPI Number	:	1063859130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKEAL ROBERT OSTRANDER O.D.

Provider Business Mailing Address
First Line	:	N901 COUNTY HIGHWAY MD
Second Line	:
City	:	SARONA
State	:	WI
Zip	:	54870-9259
Country	:	US
Telephone Number	:	715-651-1944
Fax Number	:

Provider Business Practice Location Address
First Line	:	15569 RAILROAD ST STE 301
Second Line	:
City	:	HAYWARD
State	:	WI
Zip	:	54843-5707
Country	:	US
Telephone Number	:	715-236-7906
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	04/14/2022

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